Explanation
The tongue and mucosa are soft tissue, and their cleaning involves different oral care tools and different points for attention from those for teeth cleaning. It is therefore important to fully understand the differences to perform appropriate oral care.
Explanation
Cleaning is needed in a number of places in the oral cavity, including the teeth. This cleaning of the oral cavity improves oral function and has significance as an indirect training approach.
Explanation
A variety of diseases can affect the oral mucosa. Stomatitis aphthosa is a common complaint, and oral candidiasis may be found where there are changes in the oral environment with immunosuppression, hyposalivation, or long-term antibiotic use (as in this photograph). Also, a precancerous change (eg, leukoplakia), oral cancer, and many other diseases [[or "critical conditions"]] should not be overlooked, so careful attention is required.
Explanation
For the purpose of this explanation, the cleaning tools we use will be divided into those used for the oral mucosa and those used for the tongue.
There is a range of tools that can be used to clean the soft tissue of the mucosa. This includes cotton swabs, sponge brushes, soft-bristle brushes, and wet wipes for oral care. Soft-bristle brushes are the most effective for cleaning clinically, and sponge brushes are also widely used.
For soft-bristle brushes, ultra-soft (US) toothbrushes which have very fine bristles are easy to use because they are unlikely to damage the oral mucosa. We should choose a brush that suits the condition of the patient's oral cavity.
Although wet wipes for oral care and cotton swabs can be used, they have a poor cleaning effect and it should be understood that they need to be supplemented with other tools.
Explanation
The tongue has a unique morphology, so there are many tools that have been specially designed only for tongue cleaning. We can broadly classify them into 2 types: the brush type and braid type. Brush-type tools include those with a plate and those without a plate. Because of differences in mouth-opening range and cooperativeness among individual patients, we can't say that one type should be chosen over the other, but a smaller type is less of a burden for patients.
The mucosa-cleaning tools shown in Slide 4 can also be used for the tongue.
Explanation
The chemical solutions used when cleaning the tongue and the oral mucosa are the same as described previously. The 3 types shown here are widely used clinically. The solution is diluted and also used for washing the cleaning tools.
Chemical solutions are not absolutely essential for oral cleaning; at the most, they should be used to supplement the more important mechanical cleaning using the tools.
Explanation
As a rule, oral cleaning should be applied to the whole oral cavity.
Explanation
For patients with oral dryness (xerostomia), plans for moisturization should be made in advance. Cases such as that shown here are common, and such patients are at high risk of aspiration and find it difficult to gargle. A suitable treatment for dry tongue and oral mucosa is to apply an oral moisturizing gel. Moisturizing also helps in preventing the tongue and mucosa from bleeding when performing oral care. The muscle groups around the oral cavity can be massaged at the same time as the gel is manually applied. When large amounts of plaque have adhered to the oral cavity, the gel applied is left in place for a short time so the plaque can be easily removed.
Explanation
The tongue and mucosa are cleaned while washing off the plaque that adheres to the tool by rinsing it with diluted solution. For both the tongue and the mucosa, care should be taken not to press too firmly, because excessive scrubbing can cause injury to the surface. Consideration should also be given when scrubbing the palate and dorsum of the tongue because it may stimulate the vomiting reflex. Putting out the tongue can reduce burden on the patient. (Lukewarm water may be used for rinsing as it mitigates against irritation and rejection).
One report emphasizes that thorough cleaning with a chemical solution is required because any inattentive provision of care to a dry dorsum may spread bacteria through the lingual papillae 1).
Explanation
Gargling can wash off plaque. It can also give the patient a subjective feeling of well-being, remove food debris from the oral cavity and secretions from airways, and can be a form of breathing exercise as it cleans the pharynx through stimulating the cough reflex.
The patient can be asked to gargle in the sitting position. When patients can't gargle, they can be trained to keep their lips closed and to expand the oral cavity so gargling exercises can be started using small amounts of water while leaning forward.
Posture needs to be considered carefully for patients who can't sit up, to prevent aspiration. The points to consider are: ① having an elevation of at least 30° degrees, ② having the head inclining forward at suitable angle, and ③ having the patient lean on the healthy side of the body (so that the liquid accumulates on the healthy side). Using lukewarm water for gargling to provide relief for mucosal irritation and sensitive teeth.
Explanation
When there is a risk of aspiration, use a brush with suction function, suction tips, and suction tubes to minimize aspiration during oral care, and then use a syringe or feeding cup to rinse while cleaning. Otherwise, use the feeding cup to rinse from the corners of the mouth.
Explanation
For patients with oral dryness, an oral moisturizer should be applied after oral care so as to maintain the moist condition of the oral cavity, as is done before starting oral care. There is a wide range of moisturizers available-gel, mouthwash, and toothpaste types-and we should use moisturizers which suits the individual patients.
When applying the moisturizer, thinly spread it over the regions that are dry.
Reference
- Shimizu A., Nakagawa M., Takeda: Effective Oral Care - Oral Dryness and Microbial Changes (in Japanese). Journal of Japanese Society for Parenteral and Enteral Nutrition (JSPEN), 22: 546,2007
